World Cancer Day 2019—February 4—highlights the need for urgent action to increase early-stage cancer detection, screening, and diagnosis to significantly improve patients’ chances of survival. Taking place with the theme of “I Am and I Will,” World Cancer Day—led by the Union for International Cancer Control (UICC)—aims to inspire and encourage action from individuals, the health community, and governments to improve public awareness and access to early detection, screening, and diagnosis.
Benefits of Early Diagnosis
In 2018, there were more than 18 million new cases of cancer diagnosed, of which nearly 5 million cases of breast, cervical, colorectal, and oral cancers could have been detected sooner and treated more effectively.
Early detection, screening, and diagnosis have been proven to significantly improve patient survival rates and quality of life, as well as to significantly reduce the cost and complexity of cancer treatment. However, barriers to achieving higher rates of early cancer detection need to be addressed at the individual, health system, and governmental level to significantly reduce the personal and financial burden of cancer worldwide.
The majority of cancers are amenable to early detection. When a cancer is detected at an early stage—and when coupled with appropriate treatment—the chance of survival beyond 5 years is higher than when detected at a later stage. In the United States, the 5-year survival rate for women diagnosed with cervical cancer at an advanced stage is 15%, compared to 93% if diagnosed when the cancer has not spread. This pattern holds even in lower-income settings—in India, a study among rural women with cervical cancer found the 5-year survival rate to be 9% when diagnosed at stage IV, but 78% when diagnosed at stage I.
Early diagnosis can also significantly reduce the cost of treatment. Studies in high-income countries show that treatment costs for early-diagnosed patients are two to four times less expensive than treating those diagnosed with advanced-stage cancer. A U.S. study estimates the national cost savings from early diagnosis at $26 billion per year. A study of populations in sub-Saharan Africa and southeast Asia found early intervention initiatives such as cervical cancer smear tests, colonoscopy screenings, and mammography screenings (combined with treatment) to be “highly cost-effective.”
Barriers to Early Diagnosis
There are established physical, psychological, or socioeconomic barriers to accessing early cancer detection, such as age, gender issues, feelings of shame and fear, and poor health awareness.
Age can largely influence someone’s ability to understand and communicate their early symptoms of cancer, making children particularly vulnerable. Masculine gender norms, combined with a broader lack of men’s health promotion, can prevent help-seeking behavior. The strongest factor associated with men's help-seeking behavior has been shown to be the encouragement and support of spouses and family members.
Feelings of shame and fear, combined with poor health awareness and cultural beliefs, can also keep people from seeking medical care or screening programs. In 2018, a report found 1 in 4 people would not seek medical attention after discovering a potential cancer symptom for fear of what the diagnosis would be.
To change these behaviors, cancer awareness–raising efforts must stress the importance of early diagnosis and encourage early help-seeking. In Bangladesh, a survey of patients with breast cancer reported that almost half of respondents first sought alternative treatment before seeking conventional medical advice, which resulted in an average disease presentation delay of 4 months. To achieve greater screening participation, it’s also important to ensure that programs are culturally appropriate, which could mean enhanced cultural competence training for clinical staff or an increase in the number of program educators from a cultural group.
There is also an opportunity to increase awareness among doctors, nurses, and other health practitioners to improve early cancer detection, especially at the primary care level. In the United Kingdom, a study found that most people present cancer signs or symptoms at the primary care level in the year before their formal cancer diagnosis. However, even when a health-care professional might suspect cancer, weak referral systems can often prevent them from efficiently referring these patients on to pathology services for diagnostic testing, which inevitably leads to needless delays in treatment.
When suspected patients do get referred for diagnostic testing, limited access to pathology services and diagnostic technologies can hold back health services from delivering early diagnoses and treatment of cancer. This is especially true in low-income countries where there are a large number of late-stage diagnoses—35% of low-income countries reported that pathology services were generally available, compared to more than 95% of high-income countries.
‘Treatment for All’ Initiative
This World Cancer Day, as part of its flagship “Treatment for All” initiative, UICC and its more than 1,100 member organizations across more than 170 countries are calling on governments to translate their commitments to reduce the burden of cancer into demonstrable national action. Strong early detection and timely diagnosis measures must be a part of any country’s national cancer control plan, alongside concrete measures to improve cancer prevention, treatment, and care.
To improve early detection, screening, and diagnosis, and in line with guidelines set by the World Health Organization, the UICC recommends that all governments should:
Disclosure: For more information about World Cancer Day 2019, visit worldcancerday.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.